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BackgroundCases with abnormal category, determined by thyroid fine‐needle aspiration (FNA), frequently undergo surgical resection, despite the majority of cases being identified as benign after resection. Additional diagnostic markers are needed to guide the management of patients with abnormal thyroid nodules.Materials and MethodsThe retrospective study enrolled 150 cases diagnosed abnormal by FNA cytology that had undergone molecular testing with three markers (BRAF V600E, NRAS, and KRAS) on the cell block. Seventy‐one cases had a surgical follow‐up.ResultsWhen NIFTP is not considered as malignant, positive predictive values (PPVs) of cytology and combined cytology and molecular testing (CC‐MT) were 67.6% (95% CI: 0.555‐0.782) and 89.2% (95% CI: 0.746‐0.970) (P = .004), respectively. The sensitivity of the CC‐MT was 68.8%, specificity was 82.5%, and the false‐positive rate was 17.4%. When NIFTP is considered as malignant, PPVs of cytology and CC‐MT were 83.1% (95% CI: 0.743‐0.918) and 94.6% (95% CI: 0.873‐1.018) (P = .047), respectively. The sensitivity of the CC‐MT was 59.3%, specificity was 83.3%, and the false‐positive rate was 16.7%.ConclusionThe addition of molecular testing with a small panel to FNA cytology may increase the PPV of cytology in abnormal categories. Small panel (BRAF V600E, KRAS, and NRAS) with high specificity and high PPVs may be used particularly for the detection of thyroid malignancy. Cell blocks can be an especially useful and straightforward method for molecular diagnostic studies.

A 78-year-old male patient with history of righ hemicolectomy due to adenocarcinoma was admitted by the complaint of epigastric discomfort. Laboratory data showed increase in liver biochemistries (aspartate aminotransferase (AST): 159 IU/L, alanine aminotransferase (ALT): 235 IU/L, alkaline phosphatase (ALP): 350 IU/L, gamma glutamyl transferase (GGT): 911 IU/L, total bilirubin: 1.55 mg/dl and direct bilirubin: 0.82 mg/dl). Endoscopic retrograde cholangiopancreatiography (ERCP) done after the gastrointestinal (GI) upper endoscopy was compatible with tumoral lesion, and biopsy confirmed 'neuroendocrine carcinoma'. Pylorus-preserving pancreaticoduodenectomy (PPPD) had been performed with R0 resection. Pathologic evaluation revealed 1.5 cm tumor of large cell neuroendocrine carcinoma (LCNEC). Five months later, biyopsy of suspicious lesions in liver had been documented as 'high grade neuroendocrine carcinoma metastasis'. He was referred to oncology for chemotherapy but unfortunatelly he had expired three months later. Large cell neuroendocrine carcinoma (LCNECs) of ampulla of Vater may have aggressive clinical course despite radical resections involving lymph node dissections. Small tumor size and lymph node negativity are not reliable factors for this tumor type.

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